Trocar epicystostomy: technique, care after surgery. Urinary retention

With some diseases of the genitourinary system of various etiologies, people are not able to independently go to the toilet in a small way. One of the most effective urinary excretion methods is trocar epicystostomy. During the surgery, an incision is made in the lower abdominal cavity and a special catheter is inserted, which connects to the urinal. Such a measure can act as both a temporary and permanent solution to the problem. Let's take a closer look at what this modern technique is, how it is carried out and for what purposes it is used.

In what cases do you install a urinal?

diseases of the genitourinary system

The main reason is acute urinary retention (ICD code 10 - Z93.5). This problem can develop in people as a result of a variety of factors, but among the main doctors distinguish the following:

  • mechanical blockage of the urethra;
  • bladder dysfunction;
  • constant stay in stressful situations;
  • psychosomatic disorders;
  • inflammatory lesions of the organs of the pelvic area;
  • injuries to the spinal cord or brain;
  • various infectious and viral diseases.

Regardless of the reason, the only treatment method is to install a catheter for urine, since drug therapy with paradoxical ischuria is powerless.

Indications for surgery

Let's dwell on this in more detail. Trocar epicystostomy is one of the most common treatment methods used in modern urological practice. This is due to the fact that it allows you to effectively solve a huge number of problems. Among the main indications for the appointment are the following:

  • acute ischuria, in which the release of urine in a natural way is impossible;
  • urinary retention caused by emotional shock;
  • blood clots or purulent plugs;
  • mechanical damage to the bladder;
  • benign prostatic hyperplasia;
  • cancer tumor;
  • urethritis;
  • various pathologies of the bladder;
  • the need for the introduction of medications;
  • emergency flushing;
  • treatment of certain gynecological diseases in women;
  • perinatal diagnosis of abnormalities.

With any of the above problems, drainage of the bladder allows you to organize the elimination of accumulated urine and improve the well-being of the patient.

Catheter contraindications

bladder puncture

This aspect should be emphasized. Despite its effectiveness, epicystostomy can be performed far from in all cases. Here you need to take into account the clinical picture and the diagnosis of each patient. Among the main contraindications, qualified specialists distinguish the following:

  • low bladder capacity;
  • cystitis and paracystitis occurring in acute form;
  • urethral blockage with blood clots;
  • bladder cancer;
  • reduced sphincter;
  • large scars;
  • inguinal hernia;
  • urethral prolapse;
  • acute urethritis;
  • excessive obesity.

If the patient has any of these problems, the doctor selects alternative methods of treatment, based on the clinical picture and the results of laboratory tests.

What is needed for surgery?

This treatment is not provided free of charge. The specific amount that the operation will cost is difficult to name. It all depends on which medications and procedures the patient will need for the rehabilitation period. For surgery, you need to buy a kit for trocar epicystostomy. It includes:

  • cystostomy catheter;
  • introducer needle with mandrin;
  • clamp;
  • syringe;
  • disposable scalpel;
  • clamp.

In addition to the main set, a fixing bandage will also be necessary, which is applied to the patient after the catheter and urinal are installed.

How is bladder epicystostomy?

acute urinary retention code for mcb 10

Let's dwell on this in more detail. Surgical intervention for acute urinary retention is no longer aimed at improving the well-being of a person, but at saving his life. After all, if a rupture of the bladder occurs , then this will lead to a very painful death. Doctors resort to epicystostomy in cases where it is not possible to install the urinal for some reason in the standard way.

As already mentioned above, the patient is made an incision on the abdomen and a special trocar catheter is installed. He is not only responsible for removing the spent fluid from the body, but also allows the administration of medicinal solutions in the treatment of various diseases.

Surgical intervention is carried out in stages. However, before performing it, the doctor must familiarize himself with the medical history, as well as obtain the results of some additional tests. This is necessary in order to choose the most suitable treatment program and reduce the likelihood of complications. The technique of trocar epicystostomy is as follows:

  1. The surgeon makes a small incision just below the navel.
  2. A catheter for urine is inserted between the muscle fibers and inserted into the bladder.
  3. A drainage tube is inserted through which urine will be discharged.
  4. The patient is sutured and a sterile dressing is applied.

The operation is performed using a cystoscope, so that all operations are performed with high accuracy.

Disadvantages of the procedure

In acute urinary retention (ICD code 10 - Z93.5), epicystostomy is by far the most effective treatment. However, this method is not ideal. It has certain disadvantages. According to qualified specialists, the main one is the increased sensitivity of the skin around the catheter. But here, the patients themselves are most often to blame, who do not adhere to basic hygiene standards. If you take good care of yourself, then the syndrome after a while disappears on its own. It also happens that some area at the site of the incision loses sensitivity, but it returns after removal of the catheter. Also, certain difficulties during surgery arise when the patient has problems with obesity. It is very difficult to insert a tube through a large layer of adipose tissue.

The consequences of the operation

bladder catheterization in women

In medical practice, there are cases when, after a trocar epicystostomy, urine is still poorly removed from the bladder. If you do nothing and do not go to the doctor for a long time, then this is fraught with the following problems:

  • the development of an infectious disease;
  • acute pyelonephritis;
  • kidney inflammation.

Intense and pronounced symptoms can be a special cause for concern and a serious reason for going to the doctor. Among the most alarming, the following can be distinguished:

  • fever;
  • acute pain in the abdominal region;
  • turbid urine with an unpleasant odor;
  • redness of the skin around the catheter;
  • purulent discharge.

It is also worth consulting with a specialist in the event that urine does not enter the urinal for a long time. This is especially true in cases when a bladder catheterization was performed in women carrying a child. Stagnant processes and the inflammatory process can adversely affect pregnancy and put it at risk.

Frequent Patient Mistakes

at the doctor’s appointment

After a trocar epicystostomy, patients must follow certain rules so that the rehabilitation period passes very quickly and without unnecessary problems. The main one is flushing the catheter. According to doctors, people use various antiseptic agents for this, which is strictly forbidden, since there is a great risk of infection. If urosepsis begins, accompanied by an inflammatory lesion of the bladder, then this can lead to death even in the event of a timely visit to the hospital.

Care Rules

One of the most important aspects of any surgical intervention is rehabilitation. But it depends not so much on the level of qualification of the specialist as on the patient himself and his compliance with all the requirements. For recovery to proceed normally, special care is required after the operation of a trocar epicystostomy.

The drainage and catheter are made of special inert materials, however, they are still perceived by the body as foreign bodies, so there is a high probability of rejection or the development of an allergic reaction, which, in turn, can lead to anaphylactic shock. To avoid this, you must adhere to the following rules:

  1. Wash your hands thoroughly with soap before and after any manipulation of the catheter.
  2. Monitor the urine level in the urinal and empty it in a timely manner.
  3. Fix the urinal on the body and in no case place it on dirty surfaces.
  4. Disinfect the drain with special antibacterial agents.
  5. Wash the skin in the seam area in the morning and evening.

As for taking a bath or shower, then water procedures are in principle not prohibited. But doctors advise to refrain from them throughout the entire rehabilitation period. As practice shows, it is because of bathing that allergies most often develop.

Life after surgery

trocar epicystostomy

Puncture of the bladder inflicts a severe blow to the psyche and self-confidence. And there are reasons for this, because the impossibility of independently going to the toilet is a humiliation for any man and woman. In addition, the presence of an urinal introduces certain inconveniences into the daily life of a person. The following simple tips will help you get used to it and get into a normal rhythm:

  1. It is necessary to monitor the water balance. The consumption of a large amount of fluid will reduce the likelihood of developing stagnant processes.
  2. You should temporarily abandon black tea and coffee, soda and alcohol. These drinks have an irritating effect and also slow recovery.
  3. The daily menu should be adjusted. It is necessary to exclude salty, spicy and acidic foods from it. It can lead to the development of constipation and cause various serious complications.

If you adhere to a healthy diet and observe the basic rules of personal hygiene, then there should not be any problems. But if you notice any of the symptoms described above, then you should immediately seek help from a doctor.

Catheter replacement at home

It is very dangerous to do this on your own, because due to a lack of knowledge and experience you can accidentally injure the body. But if such a need arose, then replace according to the following algorithm:

  1. Empty the urinal.
  2. Lie on your back, bend your knees and place them apart.
  3. Treat the tube with an antiseptic.
  4. Empty the catheter balloon from its contents with a 10 ml syringe.
  5. Carefully remove the tube from the urethra and insert a new one.

This manual applies to representatives of different sexes. But an independent replacement should be made only as a last resort, when there is no other way out. If possible, a qualified specialist should deal with the procedure.

Conclusion

trocar epicystostomy postoperative care

Acute urinary retention is a serious problem that poses a threat to human life. But thanks to the epicystostomy, doctors can establish the conclusion of urine. Many people are afraid of this operation and do not want to go on it, because they do not know how they will be shown to the eyes of people. But there is nothing wrong with that. After getting used to the urinal, you can return to your usual life and continue to do everyday activities.


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